Iatrogenic Bile Duct Injury and Its Management with Intensive Care Unit Process: A Single-Center Experience

Abstract

Background: The delayed recognition of bile duct injury (BDI) and the challenges in its diagnosis lead to clinical variability. The management of BDI is complicated and ranges from ERCP to liver transplantation. But infections related to BDI and sepsis control, prior to the bile flow reestablishment, are the mainstay of the treatment. In this study, we aimed to report the clinical outcomes of iatrogenic BDI and intensive care unit (ICU) process in a tertiary state hospital. Materials and methods: In this single-center, retrospective, cohort study, 17 patients admitted to our hospital with BDI after LC or ERCP were enrolled from January 2016 to July 2018. The outcomes of BDI were assessed only in short term period-as long as the length of hospital stay-and the statistical analysis was performed using SPSS version 20.0 for Windows (SPSS Inc., Chicago, IL, USA). Statistical significance was determined by a p value less than 0.05. Results: Throughout the study period, the patients with BDI were referred mostly after LC (n = 14, 82.4%). The mean age was 52.5 years and 14 of these patients were referred us from another hospital. 94.1% of the patients admitted to ICU in the first week after injury and the main symptom in the admission was right quadrant pain. Surgery was required only in seven cases (41.2%) and the in-hospital mortality rate was 17.6% (n = 3). It was clearly shown that mortality and sepsis relation was significant statistically (p < 0.001) whereas delayed admission was not related to morbidity or mortality statistically. Discussion: The rate of BDI after LC or ERCP varies and the challenge in the diagnosis of BDI is that they are not recognized at the time of LC or ERCP in the majority of cases. The identification of sepsis in the early phase leads to proper management of BDI while the morbidity and mortality rates are increasing in cases of major BDI, delayed referral and sepsis involvement. In our study, the in-hospital mortality rate was higher than the mortality rate related to BDI (17.2% vs. 7.2%) in the literature. There are many studies comparing surgical techniques and the timing of the definitive treatment while endoscopic methods have become more preferable than surgery in the early phase of BDI. Conclusion: In conclusion, early recognition of BDI after LC or ERCP is essential and the management of this feared complication requires a multidisciplinary approach with the contribution of a surgeon, gastroenterologist, and intensivist.